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    Scribes slash EMR burden

    Provider satisfaction ‘off the charts,’ says one urologist

     

    Neil Baum, MDDr. BaumNeil Baum, MD, professor of clinical urology at Tulane University School of Medicine, New Orleans, uses a scribe. He believes scribes increase the doctor’s efficiency 20% to 30%.

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    Dr. Baum told Urology Times he makes use of the “sandwich technique,” in which he meets the patient first for up to 90 seconds and has a general dialogue that doesn’t include the urologic complaint.

    “It’s more to greet them and let them see who I am. Then, I tell them the scribe, Jennifer, will come in and ask them a few questions,” Dr. Baum said. “While the scribe is taking the history of the present illness, past medical history, and review of symptoms, I can see two to three additional patients.”

    He then goes back in with the scribe to do the physical exam, communicating his findings while the scribe does the documentation. Dr. Baum tells the scribe what to write about the plan of care outside the room, then goes back in to talk about it with the patient.

    “It works so well. I’m able to see at least one additional patient per hour as a result of having a scribe. If you can see two additional patients a day, you will have more than paid the cost of the scribe,” Dr. Baum said.

    Anne M. Suskind, MD, MSDr. SuskindAnne M. Suskind, MD, MS, assistant professor of urology at University of California, San Francisco, says she loves her scribe.

    “She is with me in all of my clinics. I do two full days of clinic a week, so we spend quite a bit of time together. She’ll follow me into a room during an interview. I’ll introduce her to the patient. And she’s kind of like a fly on the wall,” Dr. Suskind said. “She just really allows me to forget about the documentation while with the patient.”

    To prepare patients for the added person in the room, Dr. Suskind enters the room first, as her scribe waits in the doorway. Dr. Suskind introduces herself, then introduces her scribe, Ashley Li, BS, explaining that Li is there to help with documentation “so I can focus on you [the patient],” Dr. Suskind said.

    In almost all cases, having her scribe in the room is a nonissue for patients, according to Dr. Suskind. She does not, however, have her scribe in the room during patient exams.

    “I do female pelvic medicine and reconstructive surgery. So, once I finish the interview with the patient, I’ll ask the patient to change for a pelvic exam. I’ll leave the room and come back by myself to perform the exam without my scribe,” Dr. Suskind said. “That’s just what I’ve decided is best for me. I’ll then come out of the patient room and I’ll fill in the details of the exam with my scribe, then, we’ll go back in the room together to complete the encounter. I sense that patients appreciate the privacy that this offers them.”

    In addition to doing most of the EMR documentation for Dr. Suskind, her scribe is a good resource for residents coming through the department.

    “She really knows my flow and what I do for patients and how the system works,” Dr. Suskind said. “The residents ask her questions all the time about how I do things, and it saves some of my time to be able to focus on the residents and their educational experience.” (Also see, “A scribe’s view: ‘Committed to delivering efficient care.' ")

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    Michael Murphy, MD, co-founder and CEO of ScribeAmerica, which staffs 78 hospitals in 13 states with scribes in urology, said one client had added daily patients to his clinic schedule and reached 100% same-day chart signing since using scribes.

    “Another site has four providers using scribes and their volumes increased 4%, 10%, 24%, and 26%, respectively. This resulted in additional $16,000 per month in revenue,” Dr. Murphy said.

    Next: Potential drawbacks

    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...

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    • brian@------.com
      Dear Anonymous, Great questions! When I first started using a scribe, our front desk handed all of my patients a written explaination detailing the scribe's role on our healthcare team. Patients were always given the option of seeing me without a scribe in the room. I almost always have my scribe step out of the room for the patient exam, unless I need a chaperone and no one else is available. I can count on one hand the number of patients in the past year who have asked to see me without a scribe in the room. We also try hard to be very sensitive to the nature of the patient's visit. Not uncommonly, my scribe will volunteer to step out of the room in an effort to make the patient feel more comfortable - particularly during discussions about sexuality and sexual dysfunction. Patients seem to really like the eye contact and focused attention that having a scribe affords me. I believe that since I started using a scribe my documentation is better and my orders and coding are more accurate. Plus, she is just super nice and really fun to work with! Again, thank you for your question. I'd be happy to try to answer any additional questions you might have about how we use a medical scribe in our office. - Brian Stork
    • Anonymous
      Scribes are all well & good for the practice. My question is did the doctor ask the patient if it was okay with them that someone else is in the room? Many don't ask the patient. Does the scribe leave the room before any exam is performed? I know in some practices they don't. I look forward to hearing from you. Regards, Raffie

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